Metformin and Cancer: Mounting Evidence Against an Association
Open accessAbstract
Metformin, a biguanide derived from the French lilac, has become the preferred first-line therapy for the treatment of type 2 diabetes (1). This drug is inexpensive, has an excellent safety profile, and can be safely combined with other antidiabetes agents (2). As a result, it has become the most widely prescribed antidiabetes drug worldwide. In addition to metformin’s well-established antidiabetes effects, there has been considerable interest in its antitumor properties. Such interest started from a short report of an observational study published in 2005 that suggested that the use of metformin was associated with a 23% decreased risk of any cancer (3). Since then, a large number of observational studies have been published with several “corroborating” a possible decreased incidence of cancer with this drug (4). In parallel, several laboratory studies have also suggested that metformin has antineoplastic activity, although doses used in such experiments were typically higher than the conventional doses used in the treatment of type 2 diabetes (5). Nonetheless, this apparent convergence of evidence from both observational and laboratory studies has led some to call for large randomized clinical trials (RCTs) of metformin in cancer prevention and treatment (6–9). However, a careful assessment of the observational studies conducted to date point to some important time-related biases that systematically exaggerated the reported antitumor effects of metformin (10). Time-related biases, such as immortal time bias, time window bias, and time lag bias, have been previously described in studies of diabetes treatment (10) and in other therapeutic areas (11–14). These biases result from not properly classifying exposure during the follow-up of a cohort study or from …
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No association has been shown between the use of metformin and a lower incidence of bladder cancer.
“For instance, no association has been shown between the use of metformin and a lower incidence of bladder cancer and concerns have also been expressed how data from observational studies are analyzed (239, 240).”
From A Critical Review of the Evidence That Metformin Is a Putative Anti-Aging Drug That Enhances Healthspan and Extends Lifespan (2021) · cites this paper as [240]
Concerns have been expressed about how data from observational studies are analyzed.
“For instance, no association has been shown between the use of metformin and a lower incidence of bladder cancer and concerns have also been expressed how data from observational studies are analyzed (239, 240).”
From A Critical Review of the Evidence That Metformin Is a Putative Anti-Aging Drug That Enhances Healthspan and Extends Lifespan (2021) · cites this paper as [240]
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- Authors
- Suissa, S., & Azoulay, L.
- Affiliations
- Jewish General Hospital (CA)
- Corresponding author
- Suissa, Samy
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-06-12
- Volume
- 37
- Issue
- 7
- Pages
- 1786-1788
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2157655280
- Cited by
- 93
- References
- 23
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 8 · 2021: 14 · 2020: 8 · 2019: 14 · 2018: 8 · 2017: 9 · 2016: 6 · 2015: 10 · 2014: 3
- FWCI
- 3.82
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Keywords
- metformin, cancer risk, anticancer activity, type 2 diabetes, observational bias, immortal time bias, cancer prevention, biguanides
- MeSH terms
- Urinary Bladder Neoplasms, Diabetes Mellitus, Type 2, Female, Humans, Male, Metformin, Sulfonylurea Compounds
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